Surgical treatment of the boutonnière deformity

Abstract

Objective: Complete restoration of extensor function.

Indications: Closed, open, and remote injuries of the extensor mechanism at the proximal interphalangeal (PIP) joint with corresponding loss of function.

Contraindications: Contracture of the PIP. Loss of the articular surfaces. Unfavorable soft-tissue conditions including inflammation.

Surgical technique: Exposure of site of lesion over the PIP. Reconstruction of the central slip either with neighboring tendinous tissue or a tendon transplant, depending on the kind of injury. Temporary immobilization of the joint with a Kirschner wire or a wire suture according to Lengemann for temporary relief of the reconstructed tendon.

Postoperative management: Immobilization of the finger on an intrinsic-plus splint for approximately 2 weeks. Thereafter, only the PIP is immobilized on a PIP splint permitting movements of the neighboring joints for 2-3 weeks.

Results: The boutonnière deformity was seen in 172 patients of whom 124 were treated surgically. Follow-up of 114 patients after an average of 40 months (6-126 months). Based on the score according to Geldmacher et al. an excellent result was seen in 24, a good in 54, a satisfactory in 22, and a poor result in 14 patients.